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News and Important InformationWhat is Medical Necessity and How Does Documentation Support It? Newsletters and ArticlesCPT Assistant ArticlesCPT® Assistant Search AHA Coding Clinic ArticlesAHA Coding Clinic® Articles Search Decision Health ArticlesDecision Health Article Search Just Coding NewsletterJustCoding® Newsletter Search BC Advantage MagazineBC Advantage Magazine & CEUs Medicare Compliance NewsletterMedicare Quarterly Provider Compliance Newsletter Find-a-Code ArticlesMedical Coding and Billing Articles Find-A-Code NewsletterFind-A-Code Focus Newsletter Select the title to see a summary and a link to the full article. October 12th, 2020 What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?| Published October 12th, 2020
When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ... June 10th, 2020 MEGA - NCCI Edit Changes - WHO Knew?| Published June 10th, 2020 There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included;
291,902 Deleted Procedure to Procedure (PTP) edits
197 Deleted Medically Unlikely ... November 19th, 2019 Changes to Portable X-Ray Requirements| Published November 19th, 2019 On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law. April 23rd, 2019 Let's Talk High Risk E/M Services| Published April 23rd, 2019 Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ... April 23rd, 2019 What is Medical Necessity and How Does Documentation Support It?| Published April 23rd, 2019 We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ... March 21st, 2019 The Impact of Medical Necessity on High Level E/M Services| Published March 21st, 2019 I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ... March 1st, 2019 Understanding NCCI Edits| Published March 1st, 2019 Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ... February 14th, 2019 Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries| Published February 14th, 2019 Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ... January 22nd, 2019 Truncated ICD-10-CM Official Guidelines for Coding and Reporting| Published January 22nd, 2019 Adherence to ICD-10-CM official guideline's are required under HIPAA and adopted for all healthcare settings. We have made it easy to access guidelines and made them available on the code information page, either on the page you are viewing or view more information by selecting the ICD-10-CM Chapter Section/Guidelines and ... There are more articles. View all articles... View articles for the current subject by subtopic: (There are no webinars at this time, please check back later.)
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